Episode 2 Peace of Mind

One in four of us will face a mental health illness

at some point in our lives.

We may know the statistic,

but what do we really know about those who live with challenging

conditions and the working lives of those involved in their care?

This series will bring them together to tell their stories.

Whitchurch Psychiatric Hospital in North Cardiff

first opened its doors in 1908.

It was designed to accommodate 750 patients

with a range of mental conditions.

In the early days, it was an unknown, unseen world.

The 20-acre site housed a theatre, a chapel, even a farm.

Life inside the asylum was a contained and controlled existence.

Patients came here for treatment and stayed for years.

The stigma attached to a stay in this hospital is still felt today.

The thought of coming into Whitchurch Hospital can be daunting.

It has got long, echoing corridors

that can't help but scare you a little, I think.

It's a prejudice, I guess, that we have to try and overcome

in getting people, sometimes, to come into hospital.

I actually trained outside Cardiff.

And I moved here with the job when I qualified.

And I came in through the front entrance,

I was walking down large, empty corridors that echoed.

You could hear people talking in the distance.

Quite an eerie experience.

And it smelt of cleaning products.

And I was like, "Wow!"

Wow. Honestly, I didn't realise it was still like this.

You slam a door over

the east side and you can hear it

at the west side of the hospital.

You have got this very old, almost quite custodial building.

You've probably seen the big locks on the doors.

I suppose, if you were director and you wanted to film a film

in a psychiatric hospital, your imagination would probably

not be that far away from the corridors and the wards

in Whitchurch.

Daily life at the hospital has long found its natural rhythm.

There are nine operational wards here, with a staff of 500.

We prepare food for about 160 patients.

And the food now is going to be picked up

from the porters,

and they'll be taken on to the wards.

So, they do the downstairs wards first and then they come back then

to do the upstairs wards.

It's a mad rush from 11.30 to 11.50.

It is really, really... You know, it's mad.

But we've got to do it, just to keep the food hot

and get their food on time.

-What have we got today then, David?

-Shepherds pie, sausage, chips.

-That OK?

-Yep.

-Hope you enjoy.

-Thank you.

-Ta-ra.

-Bye-bye.

But the hospital is now facing its final days on this site.

Modern psychiatric services in today's Wales wish to leave behind

the stigma attached to treating patients an Edwardian asylum

for good.

Wards are being closed and patients are being moved to new

purpose-built accommodation on the other side of the city.

But in the midst of this movement and change, the hospital in

Whitchurch is still opening its doors

to those who need its services.

Colin Thrupp is 51 and lives alone in Ely, in North Cardiff.

Yeah, Cardiff boy, educated at Willows High School.

Left school to work with my dad as a plasterer.

Then I went my separate way, doing my own thing,

went to London, working, Germany. Auf Wiedersehen, Pet thing!

I was non-stop active. Morning till night.

Just getting up for work, getting home from work, go fishing.

Down to the beach, or something like that.

I was always doing something or other.

I always swore blind I'd never drink. Famous last words.

I don't know what on earth possessed me to start.

Since I didn't even drink until I was 40.

Ten years down the line... a lot of differences made.

Now battling depression and alcoholism, Colin's only hope

is a two-week detox programme as an in-patient at Whitchurch Hospital,

for the second time.

I probably start three o'clock in the morning,

when I wake up with the shakes, uncontrollably.

I can't sleep because of it.

I have to have a drink to be able to go to sleep again,

to get through the night.

Upon waking, first thing again, drink. And drink and drink...

Oh, shit!

I haven't got keys. Duh!

Can you let me in, please?

Thank you.

You know, time for number eight.

We are now at 6:15...ish.

'Detox is my only route to get out of it.

'I can't wait.'

Been there once, done it once. And my birthday approached.

And I felt the urge to celebrate it with a drink.

No chance, hooked again.

Can't wait to do it this time, and it will be the last time.

Because I won't need another one.

There is a large overlap between mental health problems

and addiction problems.

So, the two go hand-in-hand together and it is important

that we don't forget the one when we are dealing with the other.

Neil Jones is Colin's consultant and will be responsible,

along with his team, for Colin's care.

The Adfer Detox Ward is one of the busiest in the hospital,

with 12 beds which are almost always full.

The waiting list to treat those dependent on alcohol or drugs

is ten weeks.

I mean, certainly addiction is classified as a disease,

part of a spectrum of mental disorders.

The people who I see who have clear addiction problems

are much more likely to have disorders

such as depression, anxiety disorders.

Here we go.

Monday has eventually arrived.

Off to the hospital now, happy days.

Couldn't come quick enough.

What are we, about 10 o'clock? In the morning.

And that'll be my fourth can.

And after today, no more.

Great.

Another one bites the dust.

I will miss drinking.

There is the way it makes me feel.

It makes me have a little bit of a party feeling,

if you know what I mean.

Makes you think you can talk to anybody

and you can let your hair down.

You don't feel embarrassed.

Whereas, when you are sober, you do, and you think,

"Nah, I'll just sit here, say nothing."

But that's the only thing. You get over that.

You too, darling. You take care, yeah?

-See you when you get back.

-Yeah, we'll get back on there.

-See you soon, baby.

-Yeah. Nice one.

Here we go again.

People who drink regularly

and become addicted or dependent

have developed such a tolerance to alcohol over time

that if they stop suddenly,

they become severely unwell.

So, somebody like Colin may have experienced really quite

major risks if he were to stop drinking suddenly.

Not the greatest level in the world of hospitals.

Yeah, a little bit of a scary place, I suppose.

Just take a deep breath and get on with it, you know?

It's for the best and you know you're going to come out the other side

and be a whole lot better.

A disused ward in another part of the hospital is home to

the North Cardiff Crisis Team.

Staff here work with people who are severely mentally unwell

but can be treated at home, rather than in hospital.

Well, it is quite strange, actually, because the ward on which

the North Crisis Team is based, West 1A, at Whitchurch, is actually

the ward which I was the consultant for when I first arrived in Cardiff.

Looking back, it seems quite shocking that people were

still in 2002 in a dormitory

in an old mental health hospital built in 1908.

But actually, then, I think, "While we've stayed in this old sort of

"Edwardian building, the work we are doing from it is very modern."

And, you know,

maybe that's a good thing, that things can change from the inside.

And even though the shell of it is the same,

the modernity of the services within it have developed.

-Shall we start, then?

-Yep.

The Monday morning meeting brings the entire team together to plan

the week ahead.

Shall we start with Tracy? Do you want to just give us some feedback?

Yeah.

Staff work intensively over a short period of crises

with the patients or service users in their care.

They assess them at home or in hospitals and police stations

around the city.

Many might be suicidal or a risk to others.

So, sharing information is crucial.

We have got a maximum capacity of 25 people, so we've got a big

board in our office with everybody's names, their particular details,

when they're going to be seen, what the risks are.

And that board can get full.

And you've got 25 people who would otherwise need to be treated

on an acute psychiatric ward if it weren't for the Crisis Team.

And they are in the community and they are your responsibility.

We see people suffering with severe mental illnesses

and major mental illnesses, such as schizophrenia,

bipolar disorder, drug-induced psychosis, severe depression,

but we also offer service to people who have more moderate to

severe depression, anxiety conditions,

acute stress reactions or adjustment reactions sometimes to things

that have happened in their life.

He was only in for about four days. I think when we saw him

he was withdrawing from alcohol.

He is still low, but there is definitely improvement.

He is not drinking.

He said he is struggling, but he is not drinking alcohol,

and I believe him, to be honest.

Everybody involved in our service gets together,

the doctors are there, the nurses.

We have represented from community mental health teams

who often refer to us. We had people from the Crisis House,

which is a service available for people who are in a social crisis

and need somewhere to live. They get representatives from the day units.

You've got a lot of professionals involved in somebody's care

And it is important we get our decisions right.

But she has been with the baby for the past six months.

That's the point, Paul. What are they going to do?

They don't even say what they're going to do.

-What is Child Protection going to do?

-Let me explain.

It can get quite heated, but that is a thoroughly positive thing

and I don't think any of us would have it any other way.

We work with people who care about their job

and are prepared to stand their ground.

So, it can be quite interesting. And it can be quite long.

You need quite a lot of coffee,

but it's...it's a very important part of our week.

So, this is one of the main corridors in Whitchurch Hospital.

The wards are arranged in a horseshoe shape around here.

This ward is empty now. There is nothing in there. East 4.

It's a rehabilitation ward for people suffering from severe

enduring mental illness. They have moved now.

They're in another part of Cardiff, in a new build.

So, an empty ward. A bit spooky.

At the front desk, Sam and his colleague

from the Crisis Team have asked for access to the assessment room -

a person in acute crisis is on her way in and they need to

decide if she needs admission to hospital or can be helped at home.

So, here we are, this is the assessment suite.

This is where you we see people who come up for assessment.

So, we tend to sit over here and people sit where they like.

And so we'll go and see this lady shortly

and ask her to come in and we will have a chat with her

and see where we can go from there.

There's probably not much we haven't heard now

in the Crisis Team about what people can be subject to,

so this is deaths of close people, relatives of people who have

been murdered, terrible physical assault,

you know, sometimes occurring over years.

I mean, one of the very common themes is that of childhood

sexual abuse.

And, you know, this is a very common occurrence,

unfortunately, in our society, it seems.

And people have psychological consequences of that.

And I am just continuously amazed at how resilient people can be

and how they can recover and move on from such terrible experiences.

You build bonds with people and they recover and you don't see them

again, that's good.

It's the ones with high emotional impact that you remember.

The ones you hear the news and it floors you

and you have to go for a walk and you can't focus for a bit

and you can't sleep for a little while.

Everyone... They are the people that you don't forgot, you know.

Um...

Yeah, it is a hard part of the job.

OK, what I need to do is just take a quick breath test from you.

Just to see where you are. OK, how are you feeling of the moment?

On the Adfer Detox Ward, Colin's medical assessment begins.

He had his last drink two hours ago.

You have done this before, yeah?

Once or twice.

'As soon as the client arrives, we will breathalyse them.

'What will often happen is the person

'makes the choice to change and then'

the morning of coming in, for instance,

or the night before even, they have a good old binge to say goodbye,

say goodbye to the alcohol.

OK, as you can see, it is going up quite high.

Hardly surprising.

'We like to get a comprehensive history'

of the clients. You know, we like to know their background,

any problems that have happened.

When did you first start drinking, Colin?

-When I was 40.

-When you were 40?

-Mm.

'There is normally some sort of reason for a person having'

become dependent on a substance,

whether that's sexual or physical abuse from childhood

or post-traumatic stress disorders.

Or whether it's a sudden lifestyle change in later life,

such as the death of a loved one or a divorce or retirement

or something a person is finding difficulty to deal with,

so that they then increase their use of alcohol.

Was there anything in your life that was happening at that time

which was difficult or stressful?

A couple of bereavements.

-It was approximately that time. My parents.

-Your parents died?

And my in-laws, as well.

I see, OK.

'Basically, it started after the passing of my parents.

'It wasn't long between both of them.'

And without that, you just take a downward tumbling,

thinking, "Oh, now what do I do?

"Where are they when I need 'em? Not here."

Well, the withdrawal symptoms are obviously as a result

of the body having become physically dependent on the alcohol.

So, there will be certain symptoms that are quite classic.

So, you'll often have a tremor.

'So, we'll obviously ask the clients to put their hands out

'and watch to see if they are shaking.'

OK, and this one.

'There'll be a lot of sort of tactile disturbances.

'It can be anything from sort of pins and needles'

to an actual feeling of spiders or ants crawling up and down the skin.

-Any sweating?

-A little bit.

-Do you mind if I feel your forehead?

-Carry on.

I suppose, what you have is a lot of different receptors talking to

the body and basically not being able to function.

So, as a result of that, the body will almost

go into a state of shock.

You're probably not surprised, but you started withdrawing.

I'm going to give you some medication for that, OK?

-So, you've had diazepam before?

-Yeah.

-So, you know it might make you feel a bit sleepy.

-Yeah.

-OK.

Diazepam is routinely used to assist a safe detox.

It helps stop the very real threat of a seizure during withdrawal,

which could be fatal.

Just here.

That'll do.

Here we go.

I'm going to have to get another member of staff,

-so we can go through your stuff.

-OK.

Not getting anything through, yeah, yeah. Yeah, no sneaky dickens.

I know.

-All right?

-Nice one. Ta-ra.

'I feel a bit anxious at the moment, but...'

..it'll...come and go.

You know, the first day is a little bit nerve-racking, I suppose.

Then it gets easy, you get to know the people

and you just tend to start to feel a bit at home then.

It'll be good once I'm off the drink to get more contact with my grandson.

Might even end up taking him fishing one day, when he is old enough.

He's only a two-year-old at the moment.

Lives about a mile away from where I live.

It will be nice to get to see him.

I wouldn't swap today for any other.

First day of the rest my life.

Hello, is that Mr Evans?

Hi there. Listen, my name is Sam, I'm a mental health nurse.

The Crisis Team offers 24-hour care, seven days a week.

Sam is on one of his regular night shifts.

Well, I'm really worried. I want to make sure

that doesn't happen. Does that make sense?

'People don't choose when they become unwell.

'And we need to be able to respond'

to that as quickly as possible,

and to get in there and alleviate that distress

and sort something out for them.

All right, well, I'll make sure the team gives you a call tomorrow, OK?

Bye.

There is a lot of information in our database,

so this gentleman is well known.

He has got a diagnosis of schizophrenia

and he can relapse and become unwell.

And when that has happened in the past,

he has ended up being detained under the Mental Health Act,

he has taken serious overdoses

and he has inflicted serious self-harm upon himself.

If somebody is borderline psychotic and afraid

they are going to go into hospital and they have been admitted before,

they made put a front on things, they may do whatever

they can to avoid admission, which is understandable.

And they may not open up to you.

You've got to be able to get a feel for that

and instinctively sort of assess the risks. Not just the obvious risks,

but get a sort of almost an intuitive feel for where

somebody is at.

Home visits happen day or night.

It can be a simple check on someone to make sure

they are taking the right medication.

'Sometimes you do need to do home treatments at three in the morning.

'You need to travel to more lively parts of Cardiff.

'And you always work in pairs.'

Then it's about four or five miles from Whitchurch.

At the end of the night, we go home.

'You do your best to use online maps

'and make sure you know exactly where you're going

'and make sure you park is close to the property as possible.

'Working the night shift, you get the whole sort of vague, bizarre,

'detachment thing, driving around and it's all quiet,

'you're wide awake, you're full of coffee.

'You've got the window down. It can be interesting.

'I quite like it, you know. And...'

there are 24-hour kebab houses in Cardiff, so that is good.

You try and avoid that, but sometimes you can't help yourself.

Ten days later, Colin's physical withdrawal from alcohol

is complete, but there is still a great deal of work to do.

'The first few days, the client tends to just feel pretty rough.

'They feel pretty poorly.

'So, the main focus is assessment and the withdrawal process.

'What we do then is we look to get them pretty much'

as busy as possible and armed with as many skills as possible.

So, we will get them into the relapse prevention groups,

which is what I do.

'So, it is looking at preparing people for going back

'into the community and hopefully breaking down

'their emotional dependence

'that they have with the substance.'

We harbour negative feelings, subconsciously, we store them.

What often then happens is that can contribute to low moods.

Low moods is often a link to lapse.

Do you see how it all interlinks?

'The classes, they are tending to make you think for yourself

'by firing questions at you. What would you do in this situation?

'Would you cope with it?

'Would you control what your thinking was?'

But it does make you think whether you would or wouldn't. It does help,

with regards to not dwelling on the fact of drinking.

These daily group therapy sessions last for ten days

and attendance is compulsory.

I feel confident coming out this time.

The first time I was here, I didn't.

I didn't feel confident at all.

I didn't know if I could trust myself.

Which turned out to be semi-true.

I managed nine months without a drink.

But that gave me false confidence then to think

I could just have the odd one or two here and there.

That is where I failed.

Very determined to make it work this time.

All right. Dog, bed.

Colin is back at home and starting a new life of sobriety.

I have been nearly two weeks of being out and I feel a whole lot better.

Be able to get up and do things without dreading it.

Um...

Getting used to being out is another thing.

If you enjoy it in there, to come out into the big, bad world then

and face all your demons,

as in refraining from drinking.

But I know I can do it.

It is just a case of getting on with it and doing it.

So, Colin goes home

and he goes home to an environment that he will associate with alcohol.

So, the hope is that he takes the skills

and experience that he took from being dry and goes on, really,

to build on that and make further changes

and build a life that he is happy with.

It takes approximately about six months

to get rid of the shakes totally.

You start doing little things

like tying small hooks on,

trying to...

I don't know whether it is through anxiety or...

But I put it down to the drink.

I tend to start t o get the shakes a little bit.

'I suppose you could look at it that I am replacing drinking with fishing.

'Obviously, you get a buzz from drinking.

'And when you have been fishing as much as I have in the past,

'you do get a buzz from that, as well.'

It is good to be back.

'There is various things in mind at the moment, in regards

'to my next step forward.'

Probably go on a computer course or something

to get computer literate.

'Look into some part-time work or something.'

'Try and think of something to get involved with.'

Got one.

Almost got away.

That was easy.

'I know it is going to be a change'

for the better, not drinking.

'It'll enable me to do a lot of things that I wouldn't otherwise do.

'I tend not'

to see much of my family because

they don't really want to know a drunken bum.

But you can't fault them.

'And I went back on the wagon...

'..so I can have more contact with my kids.

'Especially my grandson. And soon'

to have a brother in November.

So, I'll have two grandkids then.

That is another thing to motivate me not to drink.

So, I can take my grandkids fishing.

And teach them what I have learned.

Another thing to look forward to.

Subtitles by Red Bee Media Ltd